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Chapter-14 Technical Modifications in Recipient Surgery

BOOK TITLE: Liver Transplantation

Author
1. K Dilip Chakravarty
2. Lee WC
3. Jan YY
4. Lee Po-Huang
ISBN
9788184487701
DOI
10.5005/jp/books/10445_14
Edition
1/e
Publishing Year
2010
Pages
7
Author Affiliations
1. Chang Gung Memorial Hospital (Linkou), Taipei, Taiwan (ROC)
2. Chang Gung Transplantation Institute (Linkou), Chang Gung University, Taipei, Taiwan (ROC)
3. Chang Gung Memorial Hospital (Linkou), Chang Gung University, Taipei, Taiwan (ROC)
4. National Taiwan University Hospital, Taipei, Taiwan (ROC)
Chapter keywords

Abstract

Pre-portal vein thrombosis (PVT) is no longer considered an absolute contraindication for LTX. A variety of surgical techniques have been used to provide satisfactory portal vein inflow to the liver graft in the presence of portal venous thrombosis in the recipient. Incidence of pre-transplant PVT in recipients is 2% to 26% in liver transplant patients. Recurrence rate of thrombosis after initial eversion thrombectomy during transplantation is 2.4% to 28.5%. Studies have indicated improved outcomes among recipients with PVT with 1yr survival of 85% and similar 3 years and 6 years mortality rates between recipients with or without PVT. PV flow < 5 mL/min/kg is a risk factor to develop graft PVT, a search and occlusion of a spontaneous shunt is recommended to avoid the steal. Another option is to perform a reno-portal anastomosis. In the scenario of poor PVF diagnosed prior to transplantation, an arterial reconstruction should be performed first to prevent graft failure.

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